This continuation of K99 NR010750-02 requests transition to the independent (ROO phase) to support the applicant's career objective as an independent scientist focused on nursing and patient outcomes research. The objective of the research activities proposed in the ROO phase is to examine the patient outcomes for those diagnosed with invasive cancer and seeking active treatment. Through a combination of secondary analysis of existing data and collection of new primary data, the proposed research will examine the patient outcomes associated with surgical care, and with outpatient chemotherapy administration. These activities will serve as preliminary studies for an ROl application to examine the patient-reported outcomes of care in the adult outpatient chemotherapy setting. This research is in response to the National Cancer Policy Board's report that patient outcomes for those diagnosed with cancer is variable, depending on treatment setting, and the urgent need to develop interventions to strengthen the settings of care to improve patient outcomes. The ROO proposal aims are to 1) Utilize advanced health services research methods to evaluate whether ANCC Magnet Hospital status is associated with improved patient outcomes for older adults hospitalized for cancer surgery. 2) Apply cost-effectiveness analysis to evaluate the economic outcomes for patients in Magnet and non-Magnet hospitals, and; 3) Revise the Practice Environment Scale ofthe Nursing Work Index instrument to measure the practice environment of nurses working in ambulatory oncology settings. Secondary analysis of national Medicare (MEDPAR) data, which includes patients in the Surveillance, Epidemiology and End Results registry regions, will address Aims 1 and 2, while Aim 3 will be accomplished through focus groups, cognitive interviews, and pilot testing of instrument items with oncology nurses working in ambulatory facilities. After completion of these research components, the applicant will be well positioned to conduct interdisciplinary, high-impact research that articulates the role of nursing care on patient outcomes in the oncology setting.